Association of a polyester mesh-containing tissue adhesive system with early postoperative inflammatory biomarker profiles following instrumented thoracolumbar and lumbar fusion.

PURPOSE: Polyester mesh-containing 2-octyl cyanoacrylate systems are increasingly used for skin closure after spinal surgery and can simplify postoperative wound care. However, whether their use is associated with a distinct early systemic inflammatory biomarker profile following instrumented fusion remains unclear. This study compared postoperative clinical events and early CRP and CRP-to-albumin ratio (CAR) profiles between a polyester mesh-containing tissue adhesive system and conventional closure.

METHODS: This retrospective cohort study included 256 patients who underwent posterior instrumented thoracolumbar or lumbar fusion between January 2021 and July 2026. Conventional closure was used until May 2024 (n = 194), after which the tissue adhesive system was routinely adopted for eligible patients (n = 62). CRP, albumin, and CAR were assessed immediately postoperatively and at postoperative days (POD) 3 and 7. The full cohort was used for the primary analysis. Multivariable regression adjusted for demographic factors, major comorbidities, underlying diagnosis, and number of fused levels. A sensitivity analysis excluded patients with postoperative readmission and/or irrigation and debridement (I&D), and the relative reduction in CRP and CAR from POD 3 to POD 7 was evaluated.

RESULTS: Postoperative readmission and reoperation requiring I&D did not differ significantly between groups, although event counts were low. Immediate postoperative CRP and CAR were comparable. At POD 3 and POD 7, the Tissue Adhesive Group had lower CRP (6.51 vs. 11.23 mg/dL and 3.21 vs. 6.05 mg/dL, respectively) and lower CAR (all P < 0.001). These associations remained significant after multivariable adjustment (POD 3 CRP adjusted mean difference, -4.29 mg/dL; 95% CI, -5.61 to -2.97; P < 0.001) and in the sensitivity analysis. In contrast, the percentage reduction from POD 3 to POD 7 did not differ significantly between groups for CRP (P = 0.655) or CAR (P = 0.516).

CONCLUSIONS: Use of the polyester mesh-containing tissue adhesive system was associated with lower absolute CRP and CAR levels during the early postoperative period, but not with a faster relative decline from POD 3 to POD 7. These findings support an association with a lower early postoperative inflammatory biomarker profile; the clinical significance of this difference requires further prospective evaluation.